Impact of remoteness on patient outcomes for people with multiple sclerosis in Australia.

Abstract Background Little is known about whether living in remote areas is associated with worse health outcomes in Australians with MS. Objectives To evaluate whether living in remote areas was associated with worse health outcomes, employment outcomes and different disease modifying therapy (DMTs) utilisation among Australians with MS. Methods We included 1,611 participants from the Australian MS Longitudinal Study. Level of remoteness (major cities, inner regional, outer regional, remote, and very remote Australia) was determined using postcode. Data were analysed using linear, log-binomial, log-multinomial and negative binomial regression. Results Living in more remote areas was not associated with substantial worse health/employment outcomes. There was a consistent pattern of those living in inner regional areas having worse outcomes, but the effect sizes were relatively small with no clear dose-response relationships with increasing remoteness. Those living in more remote areas were less likely to use high efficacy DMTs. Adjusting for age, disease duration, and education level only marginally reduced the associations. Conclusions There is no large inequity in health outcomes in the Australian MS population due to remoteness. However, modest and consistent differences in health outcomes and DMTs treatment are likely to have a substantial cumulative impact at an individual level.